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Working with Haitian Canadian families SHARON-ANN GOPAUL-MCNICOL, 1 DENISE BENJAMIN-DARTIGUE 2 & EMERY FRANCOIS 3 1 Howard University, 109 Holly Avenue, Hempstead, New York 11550 NY, U.S.A.; 2 Multicultural Educational & Psychological Services; 3 Brentwood School District Abstract. Given the continued increase of Haitian families being referred for mental health services, a treatment model on how to intervene therapeutically would prove beneficial for both therapists and Haitian families alike. This article discusses cultural factors (family, education, language, religion, and the racial demographics of the Haitian people) that impact upon the treat- ment of Haitian families. A model for intervening therapeutically with Haitian families is proposed. Historical/Socio-political context Haiti has met with turbulence and instability from the time of the French revolution in 1789, to the present. Since Haiti had become the first black republic in the Western hemisphere, the first to gain independence (1804) (Rotberg, 1971), the first colony in Latin America to sever its political ties with North America, it was perceived as a beacon of freedom for blacks and other oppressed people and a nightmare for the colonial powers. It is this oppression that so characterized Haiti’s history, that crystallized the strength of character of the Haitian people that should earn them the respect of other African cultures. However, due to the negative propaganda of the colonial powers (France, North America and Britain), other African groups such as West Indians residing in France, North America and Britain tend to disasso- ciate themselves from Haitians. Haitians, like many other migrants coming from politically unsettled coun- tries, leave their native land to escape the repression, persecution, in search of social justice and economic advancement. The linking of Haitians to AIDS in the late 1980’s/early 1990’s resulted in many groups including those of African heritage shunning Haitians. This led to feelings of rejection by the Haitian people, embarrassment and frustration. Even though AIDS was not proven to be endemic to Haitians, to this day, some Haitians still hold resent- ment over this allegation. Many Haitians and their sympathizers have attrib- uted this allegation to their African heritage, since the rumor began when the “boat people” landed in such large numbers on Pompano beach in Florida, United States. Apparently, seeing so many people of African descent con- International Journal for the Advancement of Counselling 20: 231–242, 1998. 1998 Kluwer Academic Publishers. Printed in the Netherlands.

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Page 1: Working with Haitian Canadian families

Working with Haitian Canadian families

SHARON-ANN GOPAUL-MCNICOL, 1

DENISE BENJAMIN-DARTIGUE 2 & EMERY FRANCOIS 3

1

Howard University, 109 Holly Avenue, Hempstead, New York 11550 NY, U.S.A.;2 Multicultural Educational & Psychological Services; 3 Brentwood School District

Abstract. Given the continued increase of Haitian families being referred for mental healthservices, a treatment model on how to intervene therapeutically would prove beneficial for boththerapists and Haitian families alike. This article discusses cultural factors (family, education,language, religion, and the racial demographics of the Haitian people) that impact upon the treat-ment of Haitian families. A model for intervening therapeutically with Haitian families isproposed.

Historical/Socio-political context

Haiti has met with turbulence and instability from the time of the Frenchrevolution in 1789, to the present. Since Haiti had become the first blackrepublic in the Western hemisphere, the first to gain independence (1804)(Rotberg, 1971), the first colony in Latin America to sever its political tieswith North America, it was perceived as a beacon of freedom for blacks andother oppressed people and a nightmare for the colonial powers. It is thisoppression that so characterized Haiti’s history, that crystallized the strengthof character of the Haitian people that should earn them the respect of otherAfrican cultures. However, due to the negative propaganda of the colonialpowers (France, North America and Britain), other African groups such asWest Indians residing in France, North America and Britain tend to disasso-ciate themselves from Haitians.

Haitians, like many other migrants coming from politically unsettled coun-tries, leave their native land to escape the repression, persecution, in searchof social justice and economic advancement. The linking of Haitians to AIDSin the late 1980’s/early 1990’s resulted in many groups including those ofAfrican heritage shunning Haitians. This led to feelings of rejection by theHaitian people, embarrassment and frustration. Even though AIDS was notproven to be endemic to Haitians, to this day, some Haitians still hold resent-ment over this allegation. Many Haitians and their sympathizers have attrib-uted this allegation to their African heritage, since the rumor began when the“boat people” landed in such large numbers on Pompano beach in Florida,United States. Apparently, seeing so many people of African descent con-

International Journal for the Advancement of Counselling 20: 231–242, 1998. 1998 Kluwer Academic Publishers. Printed in the Netherlands.

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gregate in an all white community was threatening. Therefore, in order to curbthe preponderance of Haitians entering the United States, the association ofAIDS with Haitians was made, although Haitian AIDS victims made up arelatively small percentage.

There is a powerful class hierarchy (education, language, economics andculture) in Haiti distinguishing the vast majority who are Black peasants andwho represent about 90% of the population. Urban middle class Blacks,Lebanese, Syrians and Europeans represent about 4% of the population. Theelite who are descendants from the original French colonizers and African,now light skinned mulattoes, represent about 5% of the population.

Family

In Haitian culture, as in other African cultures, family is viewed in the broadestsense. The family includes the nuclear family, the extended family and evenclose friends. The extended family system serves as a base of support forfamily members who are migrating from Haiti to Canada. The newly arrivedusually find a home among already established Haitians and a support systemwhile adjusting to this new environment. In Haitian families, authority is oftenbased on the rank or position of members in the family hierarchy. Since Haitiis a patriarchal society (Weil et al., 1985), the father represents the authorityin the home, followed by the mother and then the eldest child. The father isusually the primary financial provider and the mother is usually the primarycaretaker of the home. If grandparents reside in the home, power is redefinedwith the grandparents assuming the authority. However the male spousalposition is not affected, just as the male child is more respected than the femalechild.

Elderly parents are cared for by their children or by relatives. BecauseHaitians have a profound sense of moral obligation and emotional attach-ment to the aged, they avoid placing relatives in nursing homes, since theysee this as a sign of detachment and a lack of concern for their familymembers.

Discipline

Respect for elders is highly valued in the Haitian community. When childrenviolate the rules as outlined by their elders, they are harshly disciplined.Corporal punishment such as spanking is an acceptable form of discipline.Children are beaten with a switch or belt merely for being disobedient. Theseactions are not perceived as abusive by the family, and therefore, Haitiansare usually surprised when child abuse charges are brought against them. Inthis situation the role of the therapist should be one of teaching the familiesalternative ways to discipline their children. Both parents should be taught

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behavioral principles, whereby children should only be rewarded for compli-ance, and privileges should be withheld when children fail to adhere to rules.Therefore they should be taught to set up behavioral contracts at home,whereby rules, consequences for violating rules, reinforcers (television, socialactivities etc.) should be clearly outlined. While initially parents may seemreluctant to adhere to this manner of disciplining their children, they are morereceptive when they see the positive results.

Education

Haitians view education as a very important vehicle to one’s upward socio-economic mobility (Laguerre, 1984). They value education to a great extentand they accord school teachers much respect and expect them to take on greatresponsibility in their children’s education (Foster, 1980; Joseph, 1984). Unlikein their native countries where only the elite and middle class could afford tosecure high school education making the literacy rate 20%, in North America,Haitian immigrants are described as progressive and a high percentage of pro-fessionals have been found to be among them (Joseph, 1984).

Language

The official language of Haiti is French, which is the language used in thegovernment, in business and in the school system. While French is written,spoken and understood by only 20% of the population who are mainly thewell educated elite, and middle class urbanites, everyone speaks Creole – anamalgamation of French, some Spanish, a smattering of English, and thesyntax of West African tribal languages. The politics surrounding the use ofFrench and Creole highlights the polarity of Haitian society. Speaking Frenchdoes not enable one to understand Creole and vice versa. Because only 20%of the population are truly bilingual (Weil et al., 1985), the assumption bymany Canadians that all Haitians speak French or anyone who speaks Frenchcan understand Haitian Creole, leads to mis-communication of Haitian immi-grants, mis-diagnosis of Haitian patients and mis-placement of many Haitianstudents.

Religion

Roman Catholicism, the official religion in Haiti since 1860, is thought to bepracticed by 80% of the people, while Protestantism is practiced by about 20%of the people (Weil et al., 1985; Ferguson, 1987).

Outside the urban area, one usually encounters religious folk beliefs suchas Voodoo. Voodoo has its origin in Africa and flourished on the sugar and

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banana plantations as a way for slaves to maintain their African heritage. Thisoriginal African religion is not limited to the Haitian culture, but is commonlypracticed and termed differently among people of African heritage who haveemerged from colonized systems: In Trinidad, it is called Obeah/Shango; inMartinique, Maldevidan; in Cuba, Santeria.

When Westerners hear the word Voodoo they usually associate it withwitchcraft, animal sacrifices etc. (Wittkower, 1964; Leininger, 1973; Phillippe& Romain, 1979; Weidman, 1979; Davis, 1983; Harris, 1984; Bourguignon,1985). However, like any other religion, Voodoo has its deity, angels, saints,priests and followers. For instance, there is a African Voodoo God Damballa,whom Haitians identify with the Roman Catholic Saint Patrick. In essence,Voodooism is a union of Catholicism and the African beliefs from Nigeria,Congo and other enslaved colonies.

A case sample showing the role of religion and a Haitian male

Following the incarceration of his son, a sixty year old man, Mr. X, had “asudden onset of depression”. Apparently he suddenly became withdrawn,rarely spoke and seemed listless. According to his family, for the past tenyears he was an active member of the Catholic church, although there wasno mention in his record that he had a strong religious support system. Priorto this incident, he never had a nervous breakdown or any mental problems.Due to his withdrawn behavior, he was diagnosed as “having a depressedaffect” and was placed on antidepressant medications. The primary author wasasked to serve as a consultant on the case by his family who maintained thathe did not need to be hospitalized, but needed social/spiritual support andpastoral counselling. Immediately a recommendation of spiritual consulta-tion was made to supplement the psychiatric evaluation that had been con-ducted several days prior. The evaluation which was conducted by apsychologist/theologist revealed that “the psychiatrist who did the first eval-uation was antipathic to the spiritual issues raised by the client”. Accordingto the family, the psychiatrist had “denigrated the patient’s spirituality whichwas his greatest strength”.

The interview with the patient revealed that “the psychiatrist would notlisten to the fact that he relied on his inner spiritual strength to deal with hisproblems. The patient was allowed to talk about his experiences without beingsilenced as he had said the psychiatrist had done to him. Mr. X explainedthat whenever he got the cue from the psychiatrist to stay away from spiri-tual matters, he tended to go into a mode of silence and withdrew even further.Mr. X repeatedly said “I wish I can speak freely and not have to censor thespiritual things I feel or believe”. He was encouraged to engage in his reli-gious activities, such as “blessing his home, lighting candles” etc. After herecognized that his spiritual belief system was not threatened, he was morereceptive to psychological intervention. Rational emotive therapy where the

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focus was on disputing his irrational beliefs regarding the perception ofhimself as a “bad father who failed my son” that led to his incarceration. Wewere able to work through the depression with Beck cognitive therapy andbehavioral interventions which involved visiting his son, volunteering his timein prison etc. Healthy religious activities were encouraged. After 12 weeksof treatment, Mr. X was engaging his family more, and clearly did not fit thediagnosis of depression.

In our conversation with our colleagues, we have heard a significant numberof cases about “clients who use God to avoid confronting their problems”. Wehave come to recognize that many of our psychology colleagues are unableto differentiate between healthy versus unhealthy reliance on spirituality. Wehave seen in our practice clients who cope with their psychosis by movingfrom being a skeptic to having profound faith in their religion. Interestingly,according to their pastors, many of these clients are not bizarre with respectto their theology. While we do not ourselves engage in ministrations, weencourage our clients’ spiritual growth, and their involvement in theirchurches. Even with clients who show little gains in their psychosis, muchimprovement in their soul was noted. We find it amazing that we as psy-chologists tend to overlook these gains and even denigrate them. By ignoringthe spiritual development of their clients, and even that of their own, psy-chologists are limiting their own psycho-spiritual development and are limitedin their ability to discern psychological from spiritual problems.

Therapy with Haitian families

The therapist who works with Haitian families must be willing to be flexible.Moore Hines and Boyd-Franklin (1982) and Gopaul-McNicol (1993) haveemphasized the importance of therapists exploring the impact of socio-polit-ical and broader environmental conditions on the families they treat. Treatmentissues can range from assisting families with basic concrete needs, such asthe need for food and clothing to providing translation for those who areunable to communicate in French or English. A more recent focus in treat-ment has been addressing the traumatic experiences that the Haitianpeasant/urban families endured en route to the metropolitian countries.

Firstly, it is important to note that Haitians generally do not readily acceptpsychotherapy. This is because their approach to solving problems is a familyaffair. The only outsiders that are permitted to interfere are priests, Voodooists,and elders in the community. The church’s role is basically one of reaffirmingthe family’s belief that God will solve the problem. Thus, a Haitian familymay seek treatment from mental health workers only after all internal familymeasures have failed.

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A therapeutic model for working with Haitian families – The multicultural/multimodal/multisystems approach (Multi-CMS)(Gopaul-McNicol, 1993)

The MULTI-CMS approach was developed by Gopaul-McNicol (1993). Thistechnique incorporated the works of Sue (1981) (emphasis on culture – mul-ticultural); Lazarus (1976), Bowen (1978), Minuchin (1974) – different modesof therapy – multimodal, educational, structural; and Boyd-Franklin (multi-systems).

Sue’s (1981) major point is the importance of the therapist being knowl-edgeable about the client’s cultural lifestyle. Lazarus’s (1976) multimodalapproach, which emphasizes therapeutic pluralism, utilizes a multilayeredapproach to address human discomfort. The goal is to assess the individualthrough several modalities – behavior, affect, sensations, images, cognitions,interpersonal and drugs (BASIC-ID), and then examine the salient interac-tions among them. Via this approach, a therapist is able to achieve a thoroughunderstanding of the individual and his or her social environment. In Bowen’s(1978) approach, the therapist is portrayed as a teacher who utilizes aneducational approach to therapy. This approach recognizes the value ofeducation in self-change. Minuchin’s (1974) structural approach helps inrestructuring the family that may be too enmeshed or disengaged. Thisapproach is helpful with immigrant families who find themselves losing manyof their traditional role expectations during the process of acculturation. Boyd-Franklin’s (1989) multisystems approach is useful with immigrant familieswhose experiences traditionally extend to support systems outside of thenuclear family – the extended family, friends and churches.

The MULTI-CMS approach, unlike many treatment approaches which arebased on linear models, is based on the concept of circularity and is composedof four phases. Therefore each component of each phase can recur repeat-edly at various levels throughout treatment. The therapist must therefore bewilling and flexible to intervene at whichever phase and whatever level intherapy. With this understanding, the flow of treatment for the multicultural/multimodal/multisystems approach is as follows:

Phase I. ASSESSMENT PROCESSStep 1. Initial assessment

A. Explaining the processB. Establishing trust

Step 2. Gathering informationStep 3. Determining the stage of acculturationStep 4. Outlining the goals

Phase II. EDUCATIONAL TREATMENT PROCESSPhase III. PSYCHOLOGICAL TREATMENT PROCESSPhase 1V. EMPOWERMENT TREATMENT PROCESS

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Phase I. Assessment process

Step 1. Initial assessmentThe initial assessment stage, which occurs in the first therapy session, isbroken into two phases: (1) explaining the process and (2) establishing trust.Because therapy is a relatively new phenomenon among Haitians and becausemost immigrants are taught to heal themselves within their own familialcontext, initially most Haitian families are resistant to therapy.

The next stage of this initial assessment process is the establishment oftrust. This can be done through Sue’s concepts of credibility and giving.According to Sue and Zane (1987), credibility refers to the client’s percep-tion of the therapist as a trustworthy and effective helper. Giving is the client’sperception that something was gained from the therapeutic encounter. Forimmigrant families a therapist is credible if he/she implements culturallyrelevant techniques, skills, and empathetic understanding. It is important toremember that with this model, from the inception of therapy, and withinminutes of the first session, the therapist is engaging in some form of inter-vention and some sort of problem solving.

Step 2. Gathering informationTherapists need to be aware that with most Haitians, copious note taking canbe quite intimidating and distracting, since families may feel the therapist isnot paying attention. Thus it is advised that note taking be kept to a minimumand the establishment of trust be the focus in the initial stage of treatment.

Step 3. Determining the stage of acculturationThat is determining if there is any transitional conflict in the family being inCanada after having left their native land.

Step 4. Outlining the goalsIn order to further establish credibility, it is necessary, before the end of thefirst session, to outline concisely what the individual or family will gain; thatis, the goals of therapy should be highlighted. This is to ensure that there isno discrepancy between the client’s goals and the therapist’s, since this canaffect the therapist’s credibility.

Phase II. Educational treatment process

In working with Haitian families much of the therapy may be educational innature, since many adjustment difficulties may be due to cultural differencesor a lack of knowledge about the host country’s educational, social, and polit-ical systems. Gopaul-McNicol (1993) suggested that after the assessmentprocess, if it is determined that the family members lack knowledge aboutthese basic systems, which they have to deal with every day, they may haveto be educated about these systems. This stage of therapy may also involve

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a lot of homework, such as reading (bibliotherapy) and video tapes to gainan understanding of the various systems. As can be seen, effective therapywith Haitian families requires flexibility, the use of a circular model, and eventhe removal of some traditional rigid boundaries.

Phase III. Psychological treatment process

In our experiences in working with Haitian families we have found that thecombination of Lazarus’s broad base, multimodal approach, Minuchin’s struc-tural approach, and Bowen’s family dynamics approach are the most benefi-cial in addressing the psychological problems faced by Haitian families.

Phase IV. Empowerment treatment process

The empowering of the family via a multisystems approach is the final stageof treatment. Boyd-Franklin (1989) examines the importance of interveningat various levels – individual, family, extended family, churches (Catholic orProtestant), community and social services. There is little doubt that thisapproach can be quite effective, because it provides a flexible set of guide-lines for intervention with Haitian families. Encouraging the individual toembrace the support of their extended family and nonblood kin in areas suchas child care and education, may help in preventing personal difficulties. Theuse of the church in therapy with Haitian families is also very relevant, becauseof the importance religion plays in the life of most Haitian families. Thechurch can serve as a valuable social service in times of crisis, particularlyfor single parents.

In general in utilizing this MULTI-CMS approach in counselling Haitianfamilies, a therapist can explore a broad spectrum of techniques to addressthe needs of these families.

A case example demonstrating the Multi-CMS model

Marie, a 33 year old Haitian woman was referred for psychotherapy becauseshe was given a dual diagnosis of clinical depression and paranoid schizo-phrenia by a psychiatrist. According to the referring information, her twochildren (ages 11 and seven) were taken away from her because she was saidto be a “neglectful parent” since she left her children at home unsupervised.The psychiatrist noted that Marie repeatedly complained of chest pains, haddifficulty sleeping at night and constantly made reference to a spirit that talkedto her every night to warn her that “someone is doing me evil through Voodoobecause they are jealous of me”. The psychiatrist felt that her hearing of voicesand seeing of spirits are symptoms of paranoid schizophrenia. The psychia-trist in his report also noted that a French psychologist had diagnosed Marieas retarded based on a IQ test that was given in French.

Of note in the referring information is the school reports which reflected

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both academic and behavioral difficulties of her seven year old son. Moreoverthe school psychologist noted belt marks on this child’s right arm.

Before treatment had begun, it was recommended that Marie see a medicaldoctor to rule out any physical problems. The results revealed no medicalproblems that warrant any special medical care. The report attributed her chestpains to emotional stress.

Initial session

The initial session met with resistance since Marie felt that she did not needtreatment, because like many Haitians, she felt “if I have a problem, I don’tneed a shrink. I can resolve the problem on my own.”

The interview with the therapist revealed that there were many miscon-ceptions about treatment and this was cleared up in the first session (explainingthe process of treatment – Phase 1 of the Multi-CMS approach). The conceptof psychotherapy, about a psychologist, what gains can be made from treat-ment were all clearly explained and discussed. After about 30 minutes, Mariewas not as resistant when she realized therapy was not for “crazy people”only.

In the first session, after greeting the family, the therapist asked Marie tooutline the problem as she understood it. Much anger was noted as Mariesaid that she was described as “a luni” by the psychiatrist because she simplysaid that a spirit spoke to her. The fact that the therapist understood her culturalbelief and knew that this explanation was not surprising since the Haitianculture usually attributes physical illnesses to evil doings, Marie felt under-stood and safe to express her feelings about her cultural belief. Within minutesof the first session Marie had received a “gift” from the therapist because “youunderstand me and respect my culture”. Thus the therapist’s trust/credibility(Phase 1 – Step B of the Multi-CMS) was accomplished in the very firstsession. Likewise Step 2 of Phase 1 of the Multi-CMS approach had begunfrom the moment Marie felt she could trust the therapist, since she was morerelaxed in divulging information about her family background etc. It must beemphasized that the therapist was not of Haitian background.

To address the issue of her spiritual explanation for her physical illness,she was encouraged to go to a spiritual healer if she felt that a spirit was puton her. This was done as a form of respect for her cultural belief. Althoughshe said she will not go at that time, the suggestion by the therapist resultedin her being more trusting of the therapeutic relationship. At this point shebecame more accepting of the explanation for her depression, which is thatshe was overwhelmed with responsibility in a foreign country.

Another possible explanation of her emotional stress was her experiencesin Haiti. For the newly arrived immigrants, it is important to recognize thatdue to the on-going political turmoil in Haiti, many Haitians enter Canada ina state of traumatic stress. Her depression was stemming from the aftermathof the trauma in her native country. In essence, she was experiencing some

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signs of post traumatic stress disorder. Stress management with emphasis onthe cognitive/behavioral component of Multimodal therapy was taught toMarie (Phase 111 – Psychological Treatment Process). Marie was taught relax-ation therapy and had relaxation exercises to practice at home. A relaxationtape was also given to her so she can practice these exercises before bedtimesince she had difficulty sleeping at night. Before the end of the first session,the goals for treatment were outlined as follows:

1. Refer her five year old son to a after school program so he can receivethe academic remediation he needs.

2. Teach Marie alternative ways of disciplining her children, so she will notengage in corporal punishment.

3. Teach Marie about the “do’s and don’ts” of the Canadian social system,so that she will understand the concept of neglect when a child under age14 is left home alone.

4. Refer Marie to various community programs such as the church and theemployment agencies where she can receive assistance in child care etc.and securing employment.

5. Have Marie be assessed by a Haitian psychologist who speaks HaitianCreole since French is distinctly different from Haitian Creole, the dialectMarie speaks and spoke when she was diagnosed as mentally retarded.

After outlining the goals, Marie was referred to an after school program nearto her home. Her son was offered free tutorial services. She was so excitedthat she had received a “gift” (Phase 1 – Step B of the Multi-CMS approach)from the therapist that she immediately committed to treatment for eight moreweeks. The second and third sessions involved teaching Marie alternative waysof disciplining her children and the do’s and don’ts of the Canadian socialsystems (Goals 2 & 3 of Phase 11 – Educational Treatment Process of theMulti-CMS approach). In these two sessions, the therapist educated the familyas to the social, legal and cultural differences with respect to disciplinarymethods between Canada and their native country, Haiti. The family was givensome literature to view on the video and to read on what constitutes childabuse and was asked to do so as part of the homework assignment and discussit in the next session. Subsequent sessions simultaneously focused on edu-cating the family about the principles of behaviorism, so alternatives to childabuse could be developed at home.

In session four, Marie was re-assessed by a Haitian psychologist. A reviewof the culturally sensitive non-biased assessment revealed that Marie was notretarded, but rather had little formal education prior to coming to Canada. Inother words she was deprived of formal education. Potential intellectual func-tioning revealed borderline to low average potential in intelligence. A voca-tional assessment was conducted by the therapist which revealed that Mariewas interested in becoming a nurse.

In the fifth session, Marie was referred to the Health Education Department

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where she enrolled in a Nurse’s Aide course, so she can be more self-sup-portive.

Although the Psychological Treatment Process – Phase 111 had begun fromthe moment treatment began, in that Marie was encouraged during everysession to address her feelings of loneliness, fear of never seeing her spousewhom she left behind in Haiti and fear of being a single parent. Sessions sixto nine focused exclusively on emotional/psychological issues. Thus under-standing the emotional stress and fears both children and adults experienceas a result of migration, how parents can build positive self-esteem, assertive-ness skills, study skills in their children were some of the psychological/emo-tional issues addressed. Multimodal therapy – Phase 111 of the Multi-CMSmodel was the psychological treatment of choice. Marie was taught commu-nications skills, behavioral contracting, and expressing affect (all part of theMultimodal therapy). Recognizing how she was psychosomatizing her emo-tional problems as evidenced by her physical ailments further highlighted thesensation component of Multimodal therapy.

The eleventh and twelfth sessions focused on further empowering Mariethrough community support both for herself and her children. The HaitianCommunity Center in a neighboring community was contacted and they servedas a sort of extended family support where Marie was able to socialize on aweekend.

Therapy ended after twelve sessions and all goals were met. A follow-upsix months later revealed that Marie is now a Nurse’s aide, that her childrenare doing fine.

An important fact to note in working with Haitian families is the recogni-tion that once Haitian families have agreed to therapy, they tend to perceivethe therapist as an expert, a sort of problem solver who can guide the familyin the right direction. The therapist, like the teacher and the medical doctor,is seen as an authority figure and is respected. In general Haitians expect atherapist to be active and directive, yet empathetic, and respectful of thefamily’s structure and boundaries.

References

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9: 85–104. Ferguson, J. (1987). Papa Doc, Baby Doc: Haiti and the Duvaliers. Oxford, United Kingdom:

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Joseph, C. B. (1984). The child, the family and the school in English Haitian education. In C.R. Foster (ed.), In Haiti Today and Tomorrow. Lanham: University Press.

Laguerre, M. S. (1984). American Odyssey: Haitian in New York City. New York: CornelleUniversity Press.

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129–133. Rotberg, R. I. (1971). Haiti: The Politics of Squalor. Boston: Houghton Mifflin Co. Sue, D. W. (1981). Counselling the Culturally Different. New York: Wiley.Sue, S. & Zane, N. (1987). The role of culture and cultural techniques in psychotherapy.

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